- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04957316
Blood Purification in Patients With Septic Shock
Effects of Removal of Endotoxin, Cytokines, and Uremic Toxins Using Blood Purification on Patients With Severe Septic Shock
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
In recent years, many studies have pointed out that bacterial toxin storm and cytokine storm are the main causes of patients with septic shock and multiple organ dysfunction. Endotoxins are the main mediators of gram-negative bacteria causing systemic inflammation and sepsis. Endotoxins can interact with Toll- Like receptor 4 (TLR4) binding and trigger cytokine storms. The triple-effect blood purification filter (oXiris) has been proven to remove endotoxins, cytokines and urinary toxins, and it has the opportunity to improve shock in patients with sepsis. We hypothesize that blood purification using the three-effect filter can shorten the duration and severity of shock in patients with severe septic shock and reduce the organ damage by removing endotoxin, cytokine and urinary toxins. The primary aim of this study is to investigate the effect of blood purification using the three-effect filter on shortening the duration of septic shock. Other exploratory variables include the reduction of severity of organ damage and other clinical outcomes and prognosis.
This multi-center, prospective, randomized controlled trial will enroll patient with septic shock. After the screening of eligibility and obtaining the signed informed consent, the enrolling patients will be randomly assigned to the following two groups: the control group and the blood purification group. In the control group, patients will receive the treatments for septic shock according to the Surviving Sepsis Campaign guidelines. If the primary care intensivist decides that continuous renal replacement therapy (CRRT) is indicated, the patient will receive CRRT with regular continuous veno-venous hemofiltration filter. In the blood purification group, patients will receive the treatments for septic shock according to the Surviving Sepsis Campaign guidelines. In addition, these patients will receive blood purification treatment with oXiris filter within two hours after enrollment. The blood purification treatment will be continued for up to 72 hours as needed, and a new oXiris filter will be replaced every 12 to 24 hours. If the primary care intensivist decides that continuous renal replacement therapy (CRRT) is indicated at 72h after blood purification, the patient will receive CRRT with regular continuous veno-venous hemofiltration filter.
The following information will be recorded: diagnosis of intensive care unit admission, past medical history, severity of illness, vital signs, blood pressure, infusion doses of vasopressors and inotropes, fluid balance, sequential organ failure assessment score, daily urine output, lactate, creatinine, and other regular laboratory data. Blood sample will be obtained for analysis of the levels of procalcitonin, cytokines (IL-6, IL-10, HMGB-1 and TNF-α), vascular endothelial cell injury biomarker, kidney injury biomarker and intestinal injury biomarkers.
The primary outcome is the difference of the duration of vasopressor between the two groups. The secondary is the proportion of reduction in vasoactive-inotropic score at 72h between the two groups. Other exploratory variables include the the proportion of reduction in vasoactive-inotropic score at other time points, the serum level of cytokines and organ injury biomarkers, and clinical outcomes between the two groups.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Taipei, Taiwan
- Recruiting
- National Taiwan University Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Critically ill patients with severe septic shock
- Intraabdominal infection, proved or highly suspected gram-negative bacteria infection
- Change of sequential organ failure assessment (SOFA) score is above or equal to 2
- Require norepinephrine infusion to maintain mean arterial pressure above 65 mm Hg
- Lactate level above 4 mmol/L
- SOFA score >= 9 or norepinephrine dose > 0.1 mcg/kg/min
Exclusion Criteria:
- Aged < 20
- SOFA score >=16
- Lactate level >=16
- High dose norepinephrine infusion (> 0.3 mcg/kg/min) more than 24 h after SOFA score was >=9
- High dose norepinephrine infusion (> 0.3 mcg/kg/min) more than 24 h after Lactate level was >=4
- White blood cell counts < 1000 cells/μL
- Platelet counts < 30 K/μL
- Allergy to heparin
- Receive continuous renal replacement therapy >8 hour before enrollment
- Receive other endotoxin removal filter
- Receive cardiopulmonary resuscitation within 4 weeks before enrollment
- Admitted to ICU for severe septic shock within 4 weeks before enrollment
- APACHE II score > 35 at enrollment
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control group
Conventional treatment of severe septic shock.
|
|
Experimental: Blood purification group
Conventional treatment of severe septic shock and blood purification.
|
Blood purification using the oXiris filter to remove endotoxin, cytokines, and uremic toxins.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Duration of vasopressors and inotropes infusion
Time Frame: up to 10 days
|
Compare the duration of required infusion of vasopressors and inotropes between the two groups
|
up to 10 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of reduction in vasoactive-inotropic score
Time Frame: 72 hours
|
Compare the proportion of reduction in vasoactive-inotropic score (VIS) from enrollment to 72 hours after enrollment between the two groups.
VIS = dopamine dose * 1 + dobutamine dose *1 + norepinephrine dose *100 + epinephrine dose * 100 + milrinone dose *10 + vasopressin dose x 10000.
All above medication doses are calculated with the unit of mcg/kg/min.
|
72 hours
|
Collaborators and Investigators
Collaborators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 202007010RIPD
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Severe Septic Shock
-
Indonesia UniversityCompletedSevere Sepsis With Septic Shock | Severe Sepsis Without Septic ShockIndonesia
-
German Center for Neurodegenerative Diseases (DZNE)University Hospital, BonnUnknownSevere Sepsis With Septic Shock | Severe Sepsis Without Septic ShockGermany
-
Yonsei UniversityCompletedSevere Sepsis or Septic ShockKorea, Republic of
-
University of RostockCompletedSevere Sepsis and Septic ShockGermany
-
Assistance Publique - Hôpitaux de ParisCompletedSevere Septic Syndrome (Severe Sepsis and Septic Shock) Diagnosed and Treated by Mobile Intensive Care UnitFrance
-
Klinikum EmdenUniversitätsklinikum Hamburg-Eppendorf; Kantonsspital Baden; Kantonsspital MünsterlingenCompleted
-
University Hospital, Strasbourg, FranceUnknownSevere Sepsis and Septic ShockFrance
-
Peking Union Medical College HospitalUnknownLactate | Severe Sepsis With Septic Shock
-
University of UtahNational Institutes of Health (NIH)CompletedSevere Sepsis With Septic Shock
-
Centre Hospitalier Universitaire DijonCompletedFluid Resuscitation | Severe Sepsis or Septic ShockFrance
Clinical Trials on Triple-effect blood purification filter
-
Children's Hospital of Fudan UniversityShandong Provincial Hospital; First Affiliated Hospital of Xinjiang Medical... and other collaboratorsNot yet recruiting
-
Feng LiDuke University; Rutgers University; Tsinghua UniversityCompletedRisk Factors for Respiratory and Cardiovascular DiseaseChina
-
Children's Hospital of Fudan UniversityShandong Provincial Hospital; First Affiliated Hospital of Xinjiang Medical... and other collaboratorsNot yet recruiting
-
Third Affiliated Hospital, Sun Yat-Sen UniversityZhongshan Ophthalmic Center, Sun Yat-sen University; Guangdong 999 Brain HospitalNot yet recruiting
-
Swiss Federal Institute of TechnologyUniversité d'Abomey-CalaviTerminated
-
Burdenko Neurosurgery InstituteRecruitingSeptic ShockRussian Federation
-
National Taiwan University HospitalCompletedSeptic Shock | Sepsis, SevereTaiwan
-
hemotune AGNot yet recruiting
-
Careggi HospitalUniversity of FlorenceRecruitingSepsis | Systemic Inflammatory Response Syndrome | Critical Illness | Acute Kidney InjuryItaly
-
ExThera Medical Europe BVExThera Medical Corporation; Vivantes Clinic NeuköllnRecruitingBloodstream InfectionFrance, Germany, Netherlands, Austria, Belgium, Italy, Poland, Spain, United Kingdom